Alice Dogruyol, a London-based publicist, nearly fell into a coma after her "nail varnish remover" breath was ignored as a dental issue. She was eventually diagnosed with type 1 diabetes in January 2021, following a previous misdiagnosis of type 2 diabetes in 2019.
The 'nail varnish' scent of Alice Dogruyol's ketoacidosis
For a full year,Alice Dogruyol struggled with a persistent, sour odor that she could taste in her own mouth. Despite obsessive brushing and the use of breath sprays, the scent—which her boyfriend likened to nail polish remover—would not vanish. According to the report , this was not a hygiene failure but a symptom of diabetic ketoacidosis (DKA), a critical state where the body burns fat for energy due to a lack of insulin.
This process creates ketones, which are emitted through sweat and breath, often smelling like acetone or "pear-drops." By the time Alice Dogruyol received the correct diagnosis in early 2021, medical professionals warned she was only a week away from falling into a coma. The recovery was immediate once insulin treatment began, causing the distinctive chemical odor to disappear.
Why 38 per cent of adult Type 1 patients face misdiagnosis
The case of Alice Dogruyol underscores a systemic medical oversight regarding adult-onset diabetes. As the report says, a study by researchers at the University of Exeter revealed that 38 per cent of adults diagnosed with type 1 diabetes after age 30 were initially misdiagnosed with type 2 diabetes. This error is perilous because type 1 requires immediate, daily insulin injections for survival, whereas type 2 can often be managed initially through diet and medication.
The confusion stems from the fact that type 1 diabetes was long viewed as a childhood illness. However, nearly half of all cases are now identified in adulthood. While both types share symptoms like extreme thirst and frequent urination, type 1 typically strikes within days or weeks, whereas type 2 develops over years.. The failure to distinguish between these timelines can leave patients like Alice Dogruyol without life-saving hormone replacements.
From acetone breath to the 'stale' scent of liver failure
Changes in body odor can serve as early warning signs for various systemic failures. Dr. Dean Eggitt, a GP at The Oakwood Surgery in Doncaster, explains that when the chemical composition of the body shifts due to disease, those chemicals are excreted through breath, skin, and urine. While bad breath is often caused by tonsillitis or food, Dr. Dean Eggitt notes that a new smell accompanying general illness should be treated as a "red flag."
Beyond diabetes, other organs produce distinct olfactory signals when they fail. For instance, advanced liver failure or cirrhosis can produce a musty, sweet, or sulphur-like odor. This occurs because a failing liver cannot filter toxins from the blood, leading to sulphur-containing compounds being exhaled through the lungs. Dr. Dean Eggitt describes this specific scent as resembling a "stale and mouldy" old house.
The mystery behind the rise in adult Type 1 cases
While the symptoms of type 1 diabetes are well-documented, the reason for the increase in adult diagnoses remains an open question. The source notes that the exact cause of this rise is unclear,though some theories have emerged. These include a lack of exposure to germs due to "overparenting" and low levels of vitamin D resulting from children spending less time outdoors.
However, these claims remain speculative, and the report does not provide clinical verification for these theories. It remains unknown whether these environmental factors are the primary drivers or if better diagnostic tools are simply catching more adult cases that previously went unnoticed. For now, the medical community relies on identifying "outrageous" symptoms—such as rapid weight loss and fungal infections—to catch the disease before it reaches the stage of ketoacidosis.
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